Question:
Why do insurances not want to pay very good for WLS??
Well, I was not denied for surgery, but they will only pay $1500.00. So, Traci from Liv-Lite gave me that info and I was like now what? She told me that I would have to come up with $11,000.00 (upfront to surgeon) 2 wks before surgery. Well, I certainly do not have that kind of money to do that. So, now what? I am trying to go through a different WLS hospital and see if they have a payment plan or some type of help. Has anyone else had this problem and been able to pay the very expensive up front fee? — Amy C. (posted on September 23, 2004)
September 23, 2004
Amy, I have never heard of a insurance paying so little. Either they pay or
they dont and you would have to cover the co-pay and the deductable. I
couldnt imagine that coming up to be 11,000.00. If I was you I would called
the insurance myself first thing tomorrow and get the low down. Maybe check
to see if the Dr that will be preforming your surgery is not in the net
work and that might be whats causing the high cost. You might be able to
find a doctor in the network. Whatever you do don't give up. Keep on
pushing and be positive. Sometimes it's better if you stay on things
yourself to make sure things are getting done. Best Wishes Jen:) WLS
9-15-04 -18LBS
— imgabbie
September 23, 2004
I've never heard of an insurance paying such a small amount either. My
BCBS paid all put the $20.00 co-pay for the office visit. I have a friend
who had WLS with Medicaire and it paid over $7,000.00. Live-Lite is
suppose to be the premier of organizations to get you approved in Decatur,
AL. I think your help needs to try again...judy
— juju524
September 23, 2004
That sounds like a typical surgeon's fee from ins. Now, from us directly,
it'd be whatever it is, $10,000 or something. But if they are contracted
with ins, they accept an agreed amount. Usually hospital and anesthesia are
separate. However, you're using a program, not a surgeon +
"pieces". Are you saying they'll only pay $1500 TOTAL? Of
course, they pay based on the locale, too. I know here, the surgeon gets
about $1300 on the best ins one can get (which I don't have), and I don't
know what the hospital and all else get from ins. Pre-negotiated amounts.
Very different than cash pay amounts.
— vitalady
September 23, 2004
Make sure you are using an in network provider, that will make a world of
difference. Surgeon fees do vary depending on your location, but I too
feel that 11k is high for his fee alone. Mine was 4k.
— RebeccaP
September 23, 2004
I have BCBS and went through Liv-Lite. I had no problems whatsoever,
infact they handled all of the paperwork. I wish you well!
— Jazzy
September 23, 2004
Hi Amy,
From what I was told, BC/BS was going to start limiting coverage of WLS
this year and next. Part of the way they were going to do that was to
establish "Centers of Excellence" where they would pay $7500 of
your surgery. If you chose to go to another location, (I.E. One of the
non-preferred locations...in my instance, only 2 places were going to bo
covered in all of Colorado) they would only cover....$1500
So, I believe that is where the $1500 came into play. Personally it does
make much of a difference to me when I look at it...so they cover $6000
more...most people will still need to come up with 5-7K to cover their
end...so they have effectively stopped covering it (Which is what they
want).
Anyway, I will pray that some other options come available to you.
Will
— William County
September 24, 2004
OUCH...my total bill was $66,000 thru the Mayo Clinic.
I have aetna and my total out of pocket was around 8,000
expensive but SOOO worth it..This includes all my pre op testing also and
counceling, nutritionalist etc.
— Kathy S.
September 24, 2004
You have only been approved for the initial office visit. If you decide to
go forward, you will have to meet other criterior such as medical
necessity.
— rainbowheart
September 25, 2004
I have two different types of insurance - one for doctors and the other for
hospitalization. The one for doctors (united healthcare) paid my surgeon
1300.00 for the surgery he had charged them 13,000 but the other(Empire
bluecross/shield) laid out almost 100,000 due to a couple of complications.
They paid 100% of what was submitted.
Good luck - Tracy
— tracyr
Click Here to Return